Methotrexate Treatment of Rheumatoid Arthritis: Effects on Radiological Progression

Reykdal, Sigrun; Steinsson, Kristján; Sigurjónsson, K; Brekkan, A

doi:10.3109/03009748909099932

Cited by 30 publications

(5 citation statements)

References 15 publications

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“…The 2 patients in whom there was no radiographic progression had the best clinical response to the therapy. Several other uncontrolled studies have also demonstrated a variable effect of MTX on radiographic progression (17)(18)(19)(20). The lack of control groups, as well as variation in radiographic and analytic methods, makes comparison between these studies difficult.…”

Section: Discussionmentioning

confidence: 99%

The effects of drug therapy on radiographic progression of rheumatoid arthritis. results of a 36‐week randomized trial comparing methotrexate and auranofin

Weinblatt

Polisson

Blotner

et al. 1993

Arthritis & Rheumatism

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Objective. To determine the effects of drug therapy (methotrexate [MTX] versus auranofin [AUR]) onradiographic progression in patients with active rheumatoid arthritis (RA).Methods. We conducted a 9-month randomized, multicenter, double-blind trial comparing MTX and AUR. Standardized radiographs of the hands and wrists were obtained at baseline and at completion of the study. Four experienced bone radiologists graded the radiographs for erosions, joint space narrowing, erosion healing, and reparative bone formation. Conclusion. The rate of radiographic progression in patients with RA, as measured by erosion score and joint space narrowing score, was demonstrated to be lower in those treated with MTX, as compared with AUR, over a 36-week period.The rate of radiographic progression is considered to be an important parameter of the efficacy of second-line therapy in rheumatoid arthritis (RA). Whether any second-line therapy in current use, including methotrexate (MTX), slows radiographic progression is uncertain (1,2). The clinical efficacy profile of MTX is, however, favorable, based on data from short-term randomized placebo-controlled trials (3-3, comparative studies with other second-line therapies ( 6 4 , and long-term prospective studies (9,lO). In a previously published report we described the clinical results of a 36-week multicenter study comparing MTX and auranofin (AUR) (11). The effect of treatment on radiographic activity has now been evaluated PATIENTS AND METHODSPatients. Two hundred eighty-one patients with active RA were enrolled in a multicenter double-blind trial comparing MTX and AUR (1 1). All patients had had inadequate disease response to at least 2 nonsteroidal antiinflammatory drugs (NSAIDs). Patients who had received prior treatment, of any duration, with gold salts, MTX, D-penicillamine, or cytotoxic agents were excluded from the study.Patients were randomized to receive either AUR (n = 143) or MTX (n = 138) for 9 months. (At 1 of the sites, only 1 patient was enrolled in the AUR group, and that patient was excluded from the efficacy analysis.) The initial dosage of AUR was 6 mg/day; this could be increased to 9 mg/day after 24 weeks of treatment, if there was a lack of a beneficial response with the lower dosage. The initial dosage of MTX was 7.5 mg/week, which could be increased to 15 mg/week between weeks 6 and 12 in patients who had not shown a clinical response. Patients were allowed to continue taking stable maintenance doses of background NSAIDs and/or prednisone (at a maximum dosage of 10 mg/day). Standard clinical assessments of arthritis activity were performed during the trial.Radiographic evaluation. Radiographs of the hands and wrists were obtained at baseline and at completion of the 9-month trial. A standardized protocol was used for obtaining these radiographs. All radiographs were taken on a single 30 X 35-cm cassette, with the patient in a posteroanterior position with the fingers slightly separated and the forearms flat. Each study center was provided with a Kodak (Ea...

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Section: Discussionmentioning

confidence: 99%

The effects of drug therapy on radiographic progression of rheumatoid arthritis. results of a 36‐week randomized trial comparing methotrexate and auranofin

Weinblatt

Polisson

Blotner

et al. 1993

Arthritis & Rheumatism

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“…Parenteral gold salts29-38 and MTX6-11 39 40 modify the course of rheumatoid arthritis when given in sufficient doses over a longer period of time. Although the mode of action may be different both drugs extend a similar efficacy in patients with early erosive rheumatoid arthritis 2-4…”

Section: Discussionmentioning

confidence: 99%

Prospective six year follow up of patients withdrawn from a randomised study comparing parenteral gold salt and methotrexate

Sander

Herborn

Bock

et al. 1999

Annals of the Rheumatic Diseases

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Objective-To confirm the impression of a better outcome of patients withdrawn from parenteral gold salt therapy compared with those withdrawn from methotrexate. Methods-Patients with early, active, and erosive RA were randomised for a double blind trial to receive either weekly 15 mg intramuscular methotrexate or 50 mg goldsodiumthiomalate. If the drug had to be withdrawn because of side eVects treatment was continued with the other drug in still active disease. Patients with insuYcient response were treated with a combination of both drugs. All patients were followed up by an extended clinical and radiographic evaluation. Results-64 patients each were allocated to methotrexate and gold treatment. After 72 months a complete record was available for 88% of patients. Within the first 36 months 38 patients withdrew from gold treatment (95% because of side eVects) and 23 patients withdrew from methotrexate (57% because of side eVects). A significant 40% to 70% improvement of all parameters (erythrocyte sedimentation rate, C reactive protein, swollen and tender joints, radiological progression) compared with baseline was observed in patients completing their randomised treatment with gold or methotrexate. The same improvement over three years was seen in patients who withdrew from gold treatment, while patients withdrawing from methotrexate experienced a deterioration of their disease. Conclusion-Withdrawals

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“…Reports from several clinical studies regarding the rate of radiographic progression of the joint damage are heterogeneous. Two studies found neither radiographic progression, nor radiographic improvement (absence of periarticular soft tissue swelling and juxtaarticular osteoporosis) after one year therapy in most of the patients [12][13].…”

Section: Discussionmentioning

confidence: 94%

Radiographic Assessment of Joint Damage in Early Rheumatoid Arthritis Patients Treated With Methotrexate

Spasovski¹,

Sandevska²,

Pivkova-Veljanovska³

et al. 2021

JMS

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In rheumatoid arthritis (RA), progression of the radiographic damage of hand and feet joints is a significant and objective variable for evaluation of disease activity as well as measurement of treatment outcome. The aim of this study was to evaluate the RA activity with radiographic evaluation of hand joints in patients with early RA treated with Methotrexate by using acute phase reactants, as rheumathoid factor (RF), C-reactive protein (CRP) and DAS28 index of disease activity.We tested 70 participants (35 control patients, 35 untreated RA patients). Patients were treated with Methotrexate at an average dose of 10 mg once weekly. For clinical evaluation of disease activity radiographic index (RI), sedimentation, CRP and RF in certain time intervals (0-time, after 6, 9 and 12 months) were analyzed in every patient.RI showed an increased radiographic progression of hand joint damage in time intervals between 0-time and 9 months (p=0,0167) and between 0-time and 12 months (p=0.0089). The statistical analysis showed statistically significant differences among mean values of ESR in the four-time intervals (p=0.00002).

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Methotrexate Treatment of Rheumatoid Arthritis: Effects on Radiological Progression

Cited by 30 publications

References 15 publications

The effects of drug therapy on radiographic progression of rheumatoid arthritis. results of a 36‐week randomized trial comparing methotrexate and auranofin

The effects of drug therapy on radiographic progression of rheumatoid arthritis. results of a 36‐week randomized trial comparing methotrexate and auranofin

Prospective six year follow up of patients withdrawn from a randomised study comparing parenteral gold salt and methotrexate

Radiographic Assessment of Joint Damage in Early Rheumatoid Arthritis Patients Treated With Methotrexate

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